Some upheld, recommendations

Summary

Miss C, a council tenant, complained about various aspects of the services she had received from the council. She complained that a warning marker had been put on her records, and had not been reviewed in line with policy. This marker indicated that staff should visit her in pairs. The council acknowledged that a warning indicator had been put on some of her records, and had not been reviewed, and they apologised for this. They gave assurances that none of her other records had indicators on them, but Miss C questioned this. We did not find any evidence of any other warning indicators, but were critical of the consistency of the information given to Miss C in relation to these indicators. In light of Miss C's complaint, the council told us that they had revised their procedure for recording warning indicators on customers' case notes.

Miss C also complained that there were numerous repairs required to her property, which had not been resolved by the council. We found that the council had tried to engage with Miss C on numerous occasions since she moved into her property to carry out the necessary repairs, but that they had not been able to get access to her property or she had not been satisfied with the work they had undertaken. We found that, while there were still outstanding repairs, they had made reasonable efforts to try to resolve these issues.

Miss C also expressed concern that the council had not made reasonable adjustments in the way they provided their housing services, despite informing them of her mental health needs. We identified a range of adjustments that the council had made to their services to meet Miss C's needs, in line with their policies. However, we considered that it would have been helpful for them to have procedures in place to assist staff with identifying and recording reasonable adjustments for their customers.

Recommendations

We recommended that the council:

• undertake an impact assessment of the revised procedure on protected characteristics, and amend the procedure in line with the findings;
• take steps to ensure that all warning markers are reviewed annually, and provide evidence of the steps taken;
• apologise to Miss C for the confusing information that they provided in relation to staff visiting in pairs and the marker on her records;
• consider introducing a procedure for the agreement and recording of reasonable adjustments for customers with disabilities;
• agree and record reasonable adjustments to facilitate Miss C's access to their housing repairs service; and
• consider identifying potential advisers within the council to provide information and assistance on a range of disabilities, to improve staff awareness and facilitate access to services for those with disabilities.

Summary

Miss C complained about the final account issued by the council for statutory repair works which had been undertaken on a flat she owned in Edinburgh. The project had been the subject of independent review, and further works had been undertaken (for which she had not been charged). There had been an overall reduction in the bill. However, Miss C complained to us about the council's 15 percent administration fee, because she considered this was inappropriate on top of the amount assessed by the independent review. She also complained about the tone of the council's response to her returning the discharge form with agreement to paying her share of the works minus the administration fee.

In response to our enquiry, the council said they had a legal entitlement to recover the administrative fee, and this had been reduced in line with the reduction to the final account. They explained that the company that undertook the independent review had, in some cases, made recommendations to partially or fully waive the council's administrative fee, but had not done so in this instance. Taking this advice into account, we did not uphold the complaint. Miss C had also asked for the reimbursement of her share of the cost of expenses incurred by the owners for professional services, but as this had also been considered as part of the review and a decision taken not to pay, we considered we had no grounds to challenge this.

We did uphold Miss C's complaint about the tone of the council's letter, and noted from our enquiry to the council that they accepted that her complaint was justified and were addressing the concerns which had been raised.

Recommendations

We recommended that the council:

• apologise to Miss C for the tone of the letter sent to her by the council.

Summary

Mrs A moved to a different council property because her previous property was due to be demolished. When she began redecorating, she found that the living room and bedroom walls were damp. Various inspector visits took place but Mrs A was not satisfied that reasonable repairs had taken place and she complained to the council. The council admitted fault and refunded most, but not all, the rent Mrs A had paid. Mrs A remained unhappy about the condition of her property and the rent situation, and Mr C complained to us on Mrs A's behalf.

We concluded that Mrs A's property had not been watertight when it was let to her, and that there had been an unreasonable delay by the council in repairing the roof. We also considered that the council could have more clearly explained to Mrs A why she was not entitled to a full refund of rent, and we recommended an apology and a goodwill payment to recognise that the repair work should have been done quicker. We did not uphold Mrs A's complaint about the council's refusal to undertake a comprehensive programme of works at her property.

Recommendations

We recommended that the council:

• acknowledge and apologise to Mrs A for allocating her a property which was not watertight, and for the stress she experienced due to this; and
• make a payment of redress to Mrs A of the equivalent of two months' rent.

Summary

The council had authorised entry to their contractor to a site adjacent to Mr C's street via his street, which is an unadopted road. Mr C complained to the council that they had failed to ensure that the street was returned to the condition it was in before the council required access, and also that they had failed to provide him with consistent advice about their responsibility to repair the damage. Mr C also complained that the council had failed to reply to his complaint.

Following our investigation, we found evidence that the council were satisfied with the works which had been undertaken by their contractor. As there was no evidence of fault in the way the council handled the matter, we did not uphold his complaint about this. We also did not uphold Mr C's complaint that the council had given inconsistent advice about their responsibility to repair any damage as it was evident that he had agreed to the works which the contractor would undertake, and although he was not satisfied with what was undertaken, and that his claim to the council was rejected, he had been given advice of his right of recourse to the Lands Tribunal for Scotland or the courts.

However, we found that there had been an unreasonable failure to reply to Mr C's complaint and so we upheld this, making recommendations of apology and a refresher to council staff about the council's complaints procedure.

Recommendations

We recommended that the council:

• apologise to Mr C for failing to acknowledge receipt of his complaint form, submitted in November 2013, and failure to respond to it;
• apologise to Mr C for the failure to respond to his complaint in line with their complaints procedure;
• apologise to Mr C for sending him an unsigned letter; and
• run staff training for the services involved in this complaint about how to handle complaints under their complaints procedure.

Summary

Mrs C complained to the council that she had been forced into a meeting at the end of the school day to discuss her daughter's homework, when she was anxious about collecting another of her children from a different school. She alleged that staff were intimidating and behaved unprofessionally. She also complained about how the school communicated with her. She was dissatisfied with the response she received and complained that her complaints had not been adequately and seriously addressed. Our investigation considered the correspondence between Mrs C and the council and the school, and the council's complaints handling procedure and records of investigation. We found that the council had inappropriately handled her complaint as a first stage in their procedure when more detailed investigation was required of the serious complaints made. There was no evidence that staff had behaved in the way Mrs C alleged and a second investigation addressed the points she had made more comprehensively. The council's final response identified some short-comings in communication and the timings of approach to Mrs C at the end of the school day and we upheld her complaint about how the council had dealt with her complaint.

Recommendations

We recommended that the council:

• apologise for not carrying out a full investigation when the complaint was initially made;
• remind staff of the importance of assessing complaints in terms of the appropriate stage at which they should be handled; and
• consider whether further staff training is required on the principles of good practice in complaints handling.

Summary

Mrs C was referred by her GP to the Acute Medical Unit of Ninewells Hospital after reporting a ten-day history of increasing chest and upper abdominal pain. She was admitted in the afternoon and blood tests and a measurement of her heart-rate were taken. She was then reviewed by a consultant later in the evening who told Mrs C that her condition was 'not cardiac' (not related to her heart). The blood test results were not available during this review and were not checked until the following morning. Mrs C was placed on a heart monitor overnight but when she needed to use the lavatory, she was taken off the monitor and not reconnected when she returned to bed. Mrs C was reviewed the following morning by a different consultant who told her that the blood test results confirmed she had had a heart attack.

Mrs C complained to us about the care and treatment she received from the board; about entries in her medical records; and about the response to her complaints.

Our investigation, which included taking independent advice from a medical adviser and a nursing adviser, found that while some of her care and treatment was reasonable, there were some failings. In particular, the delay in reviewing the blood test results and in not reconnecting Mrs C to the heart monitor were not considered to be reasonable.

Mrs C was also concerned that there were inaccuracies and/or fabrications in her medical records but we found no evidence of this. There was one entry which related to blood test results for another patient which had been entered into Mrs C's records. The board had acknowledged this and although we upheld this complaint, we made no recommendations in view of remedial action already taken.

Finally, Mrs C was concerned that the responses to her complaints had been unreasonable. While our investigation identified that some improvement could be made, we also found that genuine efforts had been made to address Mrs C's concerns.

Recommendations

We recommended that the board:

• take action to ensure that all medical staff on the Acute Medical Unit are reminded of the importance of following up and/or chasing test results, and undertaking all tests recommended or ordered during a patient assessment;
• take action to ensure that all nursing staff on the Acute Medical Unit are reminded of the importance of patients being kept on, or immedicately reattached to, cardiac monitors while under investigation / observation for a suspected cardiac event;
• issue a further written apology for the failings we identified; and
• take action to ensure that all staff involved in complaints handling are made aware of current and relevant guidance on apology.

Summary

Mrs C complained that the board failed to properly execute her sterilisation procedure following caesarean section – she became pregnant some months later. She said the board also failed to inform her of the risks involved in the sterilisation procedure and the alternative procedures for contraception.

We obtained independent medical advice on the complaint from one of our advisers, a consultant obstetrician and gynaecologist.

Our adviser explained that sterilisation at caesarean section had a known failure rate, even when properly performed. She said that the method of sterilisation used in Mrs C's case – the filschie clip method (where clips were applied to both fallopian tubes) - was widely used and there was no evidence that Mrs C's sterilisation was not properly performed.

Based on the documentary evidence contained in Mrs C's medical records, our adviser concluded that the board did not unreasonably fail to advise Mrs C of the risks involved in the sterilisation procedure. However, we were concerned that there appeared to be limited evidence of the counselling Mrs C received prior to her operation and that there was no evidence that she was provided with written information on the procedure and its risks, in accordance with the guidelines.

Although it was noted on the consent form for Mrs C's operation that the alternative procedures for contraception were discussed with her, there was nothing in her medical records to detail what alternatives might have been discussed. The guidelines in this area stated 'counselling and advice on sterilisation procedures should be provided'. We considered it would have been reasonable for this to have taken place prior to making Mrs C making her decision on the type of contraceptive procedure she wished to receive, but there was nothing in her records to say this happened.

Recommendations

We recommended that the board:

• feed back our decision on the complaint about the failure to advise Mrs C about contraceptive options to the staff involved;
• consider how best to demonstrate the full range of verbal and written information provided to women undergoing sterilisation and advise this office of their conclusions; and
• provide Mrs C with a written apology for failing to properly advise her of her options with regards to contraceptive methods.

Summary

Ms C complained that she had not been provided with pain relieving injections for her chronic back pain within the 18 week referral to treatment target. Ms C was initially offered injections to block the nerve with a combination of steroids and anaesthetic. A trial was carried out first, however, using just the anaesthetic, in order to ensure she would respond to these injections, as not all patients find them effective. The board did not accept her treatment had missed this target significantly, as Ms C had received the trial injection some 20 weeks after referral.

Although Ms C did respond to the trial injections, she did not wish to continue with this treatment pathway as she said she wished to proceed with surgical denervation (the blocking of a nerve supply through surgical intervention), which she had discussed as an option at an earlier consultation. When she was told a referral would need to be made to another board area for this procedure, Ms C also complained to us that she had been unreasonably refused a denervation procedure locally.

We took independent advice from a medical adviser, who is a specialist in pain medicine. The adviser said the board's definition of what constituted treatment was unreasonable and contradicted their own patient pathway information. Ms C's assessment of the delay she had experienced in receiving the injection was reasonable. We found that the board had already taken some action to address the delays experienced by Ms C, but that it was unreasonable for them not to accept that her delay had exceeded 30 weeks before she received the full injection treatment. We found the board had failed to write to Ms C as they were obliged to by NHS Scotland guidance when the 18 week target was breached, so we upheld Ms C's complaint about the unreasonable delay in treatment. However, our adviser said that it had not been unreasonable for the board not to provide a denervation service locally, as this was a specialised procedure, which needed to be carried out regularly to ensure optimum results, so we did not uphold Ms C's complaint about this.

Recommendations

We recommended that the board:

• provide details of their review into the delays Ms C experienced and evidence of the action they are taking to avoid a reoccurrence including the information provided to patients; and
• apologise unreservedly for the failure to provide treatment within a reasonable timescale.

Summary

Mr C attended his dentist for a routine check-up. During this check-up the dentist intended to scale and polish Mr C's teeth (a procedure where tartar build-up is removed from the gumline). Mr C refused, as a previous treatment had caused sensitivity to his teeth. The dentist advised Mr C that if he was unable to perform the treatment necessary then he could no longer provide treatment to Mr C and would remove him from his patient list.

Mr C complained that the dentist had not followed the correct procedures in de-registering him and the reason for de-registering him was unreasonable.

We sought independent advice from a dental adviser. The adviser explained the procedure for de-registering a patient, which involves contacting the local health board. The dentist was unable to provide evidence the correct procedure was followed and we upheld this complaint and made recommendations.

The adviser said that it was an individual clinical decision for the dentist to make about whether the relationship had broken down to the point where they could no longer treat the patient. Therefore, we did not uphold Mr C's second complaint.

Recommendations

We recommended that the dentist:

• revise the guidance on de-registering patients; and
• put in place a system for evidencing that the correct procedure is followed.

Summary

Mr C experienced dizziness and balance problems after an operation on his ear in 2007. In 2012 he was referred to Glasgow Royal Infirmary's ear nose and throat (ENT) department. After examining Mr C, the ENT consultant wrote to the GP saying that he could find no physical cause of Mr C's symptoms. He referred Mr C to the Royal Alexandra Hospital for specialist tests, but commented that he felt some of Mr C's symptoms were not genuine. The specialist tests identified that Mr C had an almost complete loss of vestibular function (the system in the ear that contributes towards balance) in his left ear. Mr C complained that the ENT consultant in the first hospital did not carry out appropriate diagnostic tests or provide suitable treatment for his condition. He also complained that the second hospital did not keep his GP adequately informed of the tests that he was undergoing or his diagnosis.

We took independent advice from one of our medical advisers, who is a consultant ENT surgeon. Although we were critical of the ENT consultant's comments in his letter to Mr C's GP, we were generally satisfied that he assessed Mr C's condition appropriately and made a suitable referral for specialist treatment. That said, we took the view that he could have given more consideration to the need for a magnetic resonance imaging scan (used to diagnose health conditions that affect organs, tissue and bone), and the potential effects of Mr C's existing medication. We were satisfied that Mr C's GP was provided with adequate information about the investigations into his symptoms and his ongoing treatment.

Recommendations

We recommended that the board:

• apologise to Mr C for the ENT consultant's suggestion that his symptoms were not genuine; and
• share our decision with the ENT consultant with a view to identifying any points of learning.